Systemic pentraxin-3 levels reflect vascular enhancement and progression in Takayasu arteritis

Abstract

IntroductionProgression of arterial involvement is often observed in patients with Takayasu arteritis (TA) thought to be in remission. This reflects the failure of currently used biomarkers and activity criteria to detect smouldering inflammation occurring within arterial wall. Pentraxin-3 (PTX3) is a soluble pattern recognition receptor produced at sites of inflammation and could reveal systemic as well as localized inflammatory processes. We verified whether the blood concentrations of PTX3 and of C-reactive protein (CRP) in patients with Takayasu arteritis (TA) might reflect vascular wall involvement, as assessed by signal enhancement after contrast media administration, and the progression of arterial involvement.MethodsA cross-sectional single-centre study was carried out on 42 patients with TA that comprised assessment of PTX3, of CRP and erythrocyte sedimentation velocity (ESR). In total, 20 healthy controls and 20 patients with Systemic Lupus Erythematous (SLE) served as controls. Vascular imaging was carried out by magnetic resonance angiography, doppler ultrasonography and computed tomography angiography.ResultsPatients with TA and SLE had higher plasmatic PTX3 and CRP concentrations than healthy controls (P = 0.009 and 0.017, respectively). PTX3 levels did not correlate with those of CRP. Patients with active systemic TA had significantly higher concentrations of CRP but similar levels of PTX3 than patients with quiescent disease. In contrast, patients with vascular inflammation detectable at imaging had higher PTX3 concentrations (P = 0.016) than those in which vessel inflammation was not evident, while CRP levels were similar. The concentration of PTX3 but not that of CRP was significantly higher in TA patients with worsening arterial lesions that were not receiving antagonists of tumor necrosis factor-α or interleukin-6.ConclusionsArterial inflammation and progression of vascular involvement influence plasma PTX3 levels in TA, while levels of CRP accurately reflect the burden of systemic inflammation. These results support the contention that PTX3 reflects different aspects of inflammation than CRP and might represent a biomarker of actual arteritis in TA.

The long pentraxin PTX3: A prototypical sensor of tissue injury and a regulator of homeostasis

“…209,210 Of interest, patients with large vessel vasculitis are often treated with anti-cytokine agents targeting in particular TNFα and IL-6. PTX3 identified vascular progression only in patients who were not being treated with anti-TNFα agents, 208 in good agreement with the role of the cytokine as a major stimulus driving PTX3 expression in vivo (see above).…”

“…However, it appears increasingly clear that elevated levels identify subgroups of patients, such as those undergoing ischemic complications that represent the evolution of vacular lumen occlusion, such as optic neuritis in Giant Cell Arteritis 207 or progression of the vascular involvement because of unrestrained mural remodeling in Takayasu Arteritis. 208 The availability of novel, more refined non-invasive imaging approaches will be instrumental for a better stratification of patients with large vessel vasculitis in homogenous groups. 209,210 Of interest, patients with large vessel vasculitis are often treated with anti-cytokine agents targeting in particular TNFα and IL-6.…”

Radiology and biomarkers in assessing disease activity in Takayasu arteritis

“…Thus, it could provide a safe, non‐invasive means of assessing changes in vascular anatomy over time. It is still a matter of debate whether MRI can add useful information to disease activity assessment with a cross‐sectional, single time‐point assessment of arterial wall edema or post‐contrast enhancement …”

Sucrose non-fermenting AMPK related kinase/Pentraxin 3 and DNA damage axis: a gateway to cardiovascular disease in systemic lupus erythematosus among Egyptian patients

“…Hollan et al 40 reported that circulating PTX3 could likely be used as a biomarker for severity of CVD in inflammatory rheumatic disease. Tombetti et al 41 reported increased PTX3 concentration in SLE and Takayasu arteritis and might represent a biomarker of actual arteritis. Consistent with our results Shimada et al 42 reported increased PTX3 concentrations in SLE patients that was significantly associated with disease activity, however a significant correlation between PTX3 concentrations and carotid atherosclerosis was not found.…”